If you ask a physician what an older patient’s most serious problems are they will usually respond with their significant medical conditions such as heart disease, diabetes or cancer. Ask the patient and they will complain more about sensory deprivation – loss of vision and hearing.
This information makes a report just released by the Center for Disease Control (CDC) particularly alarming. A survey of 11,503 adults over the age of 40, who were known to have mild to moderate visual impairment, found that 39.8 percent did not have an eye examination in the previous year because of the lack of insurance or cost.
Thirty five percent did not seek eye care because they felt they did not need it and 4.5 percent stated they could not get an appointment. Obviously, those over the age of 65 who had access to Medicare used lack of insurance a reason for not seeing an eye doctor much less frequently (23.3 percent).
Remarkably 43.8 percent of Medicare recipients felt they did not need to see an eye doctor, compared to 32.9 percent for those under age 65. Men were less interested in eye exams (41.7 percent) than women (28.7 percent)
Seeking eye care varied by state. For those living in Massachusetts, 21.6 percent of those under the age of 65 did not feel the need for eye care compared to 60.4 percent of those living in Tennessee. For Medicare recipients, 61 percent did not seek care in Massachusetts, compared to 25.4 percent in Florida.
This information should be an urgent wake up call for public health officials, health care providers and the population at large. Vision is perhaps the most precious of all our sensory functions and loss of eyesight, often occurring insidiously over time is a cause of functional dependency and a poor quality of life. Most importantly, for many conditions, appropriate medical management can prevent blindness.
For younger persons, visits to the ophthalmologist or optometrist primarily evaluates visual acuity and the need for glasses but always includes screening to identify the common causes of eye disease – cataracts, glaucoma, macular degeneration and retinal disease.
Although some primary care physicians can evaluate eye sight and measure eye pressure, the level of skill required to accurately evaluate the eye is exclusively the domain of the ophthalmologist or the optometrist who is well trained in all aspects of assessing vision and screening for eye diseases.
The most common cause for significant visual loss is a cataract, which is a painless clouding of the lens of the eye that interferes with the transmission of light to the back of the eye or retina. Common symptoms include blurred vision, rings around lamps and trouble driving at night. Surgery is needed if vision is impaired sufficiently to interfere with daily functions.
Testing for glaucoma is critically important as vision loss progresses so slowly that a serious problem may not be identified until virtual blindness is present. Glaucoma is caused by increased eye pressure that damages the optic nerve, impairing the ability to transmit visual images to the brain.
Untreated there is a gradual loss of peripheral vision, eventually leading to total blindness. The disease is easily diagnosed by measuring eye pressure and treated with drops to lower pressure. Sometimes surgery is needed.
Macular degeneration results in damage to the retina. In direct contrast to glaucoma, central vision is lost but peripheral vision remains intact. Learning to look at objects out of the side of the eye can be achieved by low-vision rehabilitation.
While the cause is unclear and there is no cure for macular degeneration, treatment with vitamins, laser therapy and visual aids can be helpful. Most patients have a benign, gradually progressive disease, but some can progress very rapidly (wet macular degeneration).
Many patients with diabetes develop blindness due to blockages of tiny vessel in the retina (at the back of the eye). This leads to scarring and overgrowth of fragile new vessels that are prone to bleeding and retinal detachment. Regular eye examinations are critical.
No matter your age, remember eye examinations are essential. Not only will serious medical conditions identified early but just as importantly you will learn what you need to do to assure optimal eye health.
Dr. David Lipschitz is the medical director for the Mruk Family Education Center on Aging and the Fairlamb Senior Health Clinic. Contact him at firstname.lastname@example.org.
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